Medicine and Health Sciences Commons^™

Impact Of Health Information Technology Patient Education With "Teach-Back" On Patient Satisfaction And Hospital Readmissions, Judi Dunn

DNP Projects

Background: With the advances in medical care, patients are being asked to manage more complicated self-care regimens, and there is often a gap between what the nurse teaches and what the patient understands. This can lead to re-hospitalizations that are burdensome for patients and are costly to the American healthcare system. The Department of Health and Human Services (DHHS) challenged healthcare organizations to leverage technology that engages patients in self-management support and encourages clinician use of patient-centered communication techniques, such as teach-back.

Purpose: The purpose of this project is to evaluate the use of health information technology along with an …

Kentucky’S Primary Care Workforce Shortages 2016 - 2025 And Recommendations For Increasing The Production Of Primary Care Physicians For Kentucky, Kevin A. Pearce, Carol Hustedde, Linda M. Asher, Sydney P. Thompson, Frances J. Feltner, Katherine Mckinney

Center of Excellence in Rural Health Workforce Reports

An excerpt from the executive summary:

Kentucky and the nation face severe shortages of primary care (PC) physicians. PC physicians are essential to cost-effective healthcare. Kentucky ranks 40^th among the United States in its PC physician workforce per 100,000 people, with 2,696 practicing PC physicians statewide.

The purposes of this white paper are to:

1. Present up-to-date data and information about the primary care workforce in Kentucky
2. Describe current trainee pipelines that supply new primary care physicians to Kentucky
3. Recommend strategies and tactics for improving the primary care physician workforce

Altered Cerebellar Circuitry Following Thoracic Spinal Cord Injury In Adult Rats, Nishant P. Visavadiya, Joe E. Springer

Physical Medicine and Rehabilitation Faculty Publications

Cerebellar function is critical for coordinating movement and motor learning. However, events occurring in the cerebellum following spinal cord injury (SCI) have not been investigated in detail. We provide evidence of SCI-induced cerebellar synaptic changes involving a loss of granule cell parallel fiber input to distal regions of the Purkinje cell dendritic tree. This is accompanied by an apparent increase in synaptic contacts to Purkinje cell proximal dendrites, presumably from climbing fibers originating in the inferior olive. We also observed an early stage injury-induced decrease in the levels of cerebellin-1, a synaptic organizing molecule that is critical for establishing and …

Challenges Of Internet And Social Media Use In Adolescents, Mandakini Sadhir, Stephanie J. Stockburger, Hatim A. Omar

Pediatrics Faculty Publications

There has been tremendous growth in use of technology in recent decades. The majority of teens now have access to a desktop/laptop computer as well as a gaming console and smartphone. With growing internet and social media use teens now face challenges including cyberbullying, sexting and problematic internet use that result in various health implications. Health care providers are in unique position to educate adolescents and families about current challenges and provide age appropriate guidance to promote healthy internet behaviors.

Communicating Social Support: Understanding Complexities Of Breastfeeding Communication Among African American Mothers, Nicole Rachael Peritore

Theses and Dissertations--Communication

Breast milk is the best choice for meeting the nutritional needs for an infant whenever possible. Despite the knowledge that this nutritional choice is the best choice for an infant, data demonstrates that there is a sharp decline in the rates of breastfeeding mothers. Among African Americans, breastfeeding rates are significantly lower than the national averages. Despite many of the applications of social support in communication research, there is a gap in knowledge on the social support systems in the context of breastfeeding, especially for African Americans. With the social ecological model as a framework, social support theory provides understanding …

The Link Between Smoking, Lung Cancer And Socioeconomic Factors In Kentucky, Shreya Berlia

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Background and Purpose

Lung cancer is the leading cause of cancer death and the second most diagnosed cancer in both men and women in the United States. An estimated 158,080 deaths from lung cancer are expected to occur in 2016, which will account for approximately 1 in 4 of all cancer deaths. The 1- and 5-year relative survival rates for lung cancer are 44% and 17%, respectively. The incidence rate for lung cancer has been declining since the mid-1980s in men, but only since the mid-2000s in women. Tobacco smoke is the leading cause of preventable disease and death in …

Quality Improvement In The Department Of Family And Community Medicine At The University Of Kentucky, Manisha Vasishta

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

The purpose of this capstone project is to analyze the quality improvement data that was collected in order to increase the pediatric population at the University of Kentucky Department of Family and Community Medicine clinic at Turfland. There were three different patient populations that were surveyed: reproductive aged women between 18 and 40, parents of the pediatric population that the clinic saw between July 2014 and June 2015, and pregnant women between July 2014 and June 2015. The results show that continuity of care and not being able to see the provider of choice were some of the weaknesses that …

Behavioral Modification Program To Control Obesity Among School Children In Knott County, Kentucky, Samjhana Shakya

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Childhood obesity is one of the major public health concerns in the United States (US). Obese children have a greater likelihood of developing cardiovascular disease risk factors such as high blood pressure and cholesterol, and impaired blood glucose[7].The prevalence of obesity among children 2 to 5 years of age in Kentucky was 15.7% (US average 8.4%) and 17.6% (US average 17%) among adolescents in Kentucky being higher than the national averages [8,3].

A major goal of the Behavioral Modification Program is to promote healthy behaviors among elementary school children to control obesity by modifying eating, physical activity and screen time …

The Impact Of An Ambulatory Clinical Intervention On Viral Load Suppression And Retention In Care For Newly Diagnosed Hiv Persons, Latasha R. Jones

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Ambulatory clinical healthcare settings that serve patients infected with the human immunodeficiency virus (HIV) are critical in improving access to quality HIV care and treatment, in part due to their ability to streamline patient care along the HIV care continuum. Barriers to HIV care are significant among newly diagnosed HIV patients and in order to engage and retain these individuals in care and treatment, specific interventions must be in place to link these individuals to care. In this study, the difference in differences method was used for data analysis to measure the impact of an ambulatory clinics intervention on their …

Access For Adolescents: Multisystemic Therapy In The Juvenile Justice System, Meagan Pilar

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

In this application for funding, DC YouthLink, a non-profit organization that connects adolescents in the juvenile justice system to community resources, proposes to implement an evidence-based mental health intervention into the juvenile justice system in Washington D.C. The Director of DC YouthLink will serve as the Principal Investigator for this pilot program; she, along with five trained staff members, will be responsible for implementing multisystemic therapy (MST), an intensive form of therapy designed specifically for at-risk youth and their families. We propose to intervene at three main stages of the juvenile justice system— intake, correctional placement/probation supervision, and reentry. The …

Enough Smoke: Implementation Of An Evidence-Based Smoking Cessation Program In Owsley County, Kentucky, Meghan Fay Johnson

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

In 1964, the first United States (U.S.) Surgeon General’s Report explicitly stating the dangers of smoking, including an increased risk of lung cancer, was released. Fifty years later, the U.S. continues to carry the significant health and economic burdens for failing to heed this public health warning. Owsley County, Kentucky, located in the heart of the Appalachian is one of the most impoverished and medically underserved counties in the U.S., ranking last in almost every category of overall health outcomes in the state. The county is also entirely rural, with no major cities within an 80-mile radius. In every health …

Focas Appalachia: A Cervical Cancer Prevention Program For The Women Of The Kentucky River Area Development District, Chrisanthi M. Masero

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

In response to the National Institute of Health’s (NIH) funding announcement, the Kentucky River District Health Department (KRDHD) proposes to implement an evidence-based cervical cancer prevention program in the Kentucky River Area Development District (KRADD) in southeastern Appalachian Kentucky. The proposed evidence-based program was part of the National Cancer Institute’s (NCI) “Public Health Approaches to Breast and Cervical Cancer” research initiative and is one of nine cervical cancer Research Tested Intervention Programs (RTIPs) on the NCI’s RTIP database. The Forsyth County Cancer Screening Project (FoCaS) was designed to improve the beliefs, attitudes, and behaviors regarding breast and cervical cancer screening …

Use Of Continuous Renal Replacement Therapy For Removal Of Dabigatran In A Patient In Need Of Emergent Surgery, Sara E. Parli, Melissa L. Thompson Bastin, Daniel A. Lewis

Pharmacy Practice and Science Faculty Publications

Purpose. To report the ability to remove serum dabigatran using continuous renal replacement therapy (CRRT) in a patient with life-threatening bleeding. Summary. A 77-year-old female with history of atrial fibrillation who takes dabigatran for stroke prevention presented with abdominal pain. Patient was found to have bleeding and possible mesenteric ischemia and was taken to the operating room and had continued bleeding postoperatively. CRRT was initiated for the removal of any remaining dabigatran, with serum dabigatran levels collected to evaluate removal of dabigatran with CRRT. This patient had an increased dabigatran level prior to intervention, which decreased to an …

A Branch Point Of Streptomyces Sulfur Amino Acid Metabolism Controls The Production Of Albomycin, Aditya Kulkarni, Yu Zeng, Wei Zhou, Steven Van Lanen, Weiwen Zhang, Shawn Chen

Pharmaceutical Sciences Faculty Publications

Albomycin (ABM), also known as grisein, is a sulfur-containing metabolite produced by Streptomyces griseus ATCC 700974. Genes predicted to be involved in the biosynthesis of ABM and ABM-like molecules are found in the genomes of other actinomycetes. ABM has potent antibacterial activity, and as a result, many attempts have been made to develop ABM into a drug since the last century. Although the productivity of S. griseus can be increased with random mutagenesis methods, understanding of Streptomyces sulfur amino acid (SAA) metabolism, which supplies a precursor for ABM biosynthesis, could lead to improved and stable production. We previously characterized the …

Purin-6-One Derivatives As Phosphodiesterase-2 Inhibitors, Wei Yuan, Xin-Yun Zhao, Xi Chen, Chang-Guo Zhan

Pharmaceutical Sciences Faculty Publications

A series of purin-6-one derivatives were synthesized, and their in vitro inhibitory activity against phosphodiesterase-2 (PDE2) was evaluated by using a fluorescence polarization assay. Three compounds, that are, 2j, 2p, and 2q, showed significant inhibitory activity against PDE2 with IC₅₀ values of 1.73, 0.18, and 3.43 μM, respectively. Structure-activity relationship (SAR) analysis was performed to explore the relationship between the chemical structures of these compounds and their inhibitory activity. Compounds 2j, 2p, and 2q were further selected for molecular docking study. The docking results suggested that these ligands bind with hydrophobic pockets of …

Salvage Brachytherapy For Biochemically Recurrent Prostate Cancer Following Primary Brachytherapy, John M. Lacy, William A. Wilson, Raevti Bole, Li Chen, Ali S. Meigooni, Randall G. Rowland, William H. St. Clair

Urology Faculty Publications

Purpose. In this study, we evaluated our experience with salvage brachytherapy after discovery of biochemical recurrence after a prior brachytherapy procedure. Methods and Materials. From 2001 through 2012 twenty-one patients treated by brachytherapy within University of Kentucky or from outside centers developed biochemical failure and had no evidence of metastases. Computed tomography (CT) scans were evaluated; patients who had an underseeded portion of their prostate were considered for reimplantation. Results. The majority of the patients in this study (61.9%) were low risk and median presalvage PSA was 3.49 (range 17.41–1.68). Mean follow-up was 61 months. At last follow-up after reseeding, …

The Role Of Capillaries In The Lesser Ailments Of Old Age And In Alzheimer's Disease And Vascular Dementia: The Potential Of Pro-Therapeutic Angiogenesis, Charles T. Ambrose

Microbiology, Immunology, and Molecular Genetics Faculty Publications

Apart from chronic diseases (arthritis, diabetes, etc.), old age is generally characterized by three lesser ailments: muscle weakness, minor memory lapses, and cold intolerance. This trio of complaints may have a common, underlying cause, namely, the age-associated reduced microcirculation in muscles, brain, skin, and elsewhere in the body. The Angiogenesis Hypothesis proposes that old age is in part a deficiency disease due to the decline in angiogenic (AG) factors, resulting in a reduced capillary density (CD) throughout the body. Over fifty published papers document waning levels of AG factors and/or decreased CD in various organ systems of aged animals and …

Role Of Sulfiredoxin Interacting Proteins In Lung Cancer Development, Hedy Chawsheen

Theses and Dissertations--Toxicology and Cancer Biology

Sulfiredoxin (Srx) is an antioxidant enzyme that can be induced by oxidative stress. It promotes oncogenic phenotypes of cell proliferation, colony formation, migration, and metastasis in lung, skin and colon cancers. Srx reduces the overoxidation of 2-cysteine peroxiredoxins in cells, in addition to its role of removing glutathione modification from several proteins. In this study, I explored additional physiological functions of Srx in lung cancer through studying its interacting proteins. Protein disulfide isomerase (PDI) family members, thioredoxin domain containing protein 5 (TXNDC5) and protein disulfide isomerase family A member 6 (PDIA6), were detected to interact with Srx. Therefore, I proposed …

Subacute Effects Of Prallethrin On Behavior Of Mosquitoes (Diptera: Culicidae) And Other Human Disease Vectors, Kyndall C. Dye

Theses and Dissertations--Entomology

The synthetic pyrethroid, prallethrin, is an active ingredient in a widely marketed ultralow volume (ULV) mosquito adulticide. Volatilized prallethrin is intended to stimulate mosquito flight, increasing overall effectiveness of the adulticide. However, field tests using volatilized prallethrin did not produce significant differences in various vector trap catches, suggesting prallethrin’s behavioral effects are not viable. Laboratory tests were conducted to evaluate prallethrin’s effect on flight behavior of adult female Asian tiger mosquitoes (Aedes albopictus). Mosquitoes were divided into three groups; a control, those exposed to volatilized prallethrin, and those exposed to a simulated ULV application at label rates. After …

Probing The Functional Relevance Of Reactive Hippocampal Neurogenesis In A Model Of An Alcohol Use Disorder, Chelsea Rhea Geil Nickell

Theses and Dissertations--Pharmacy

Alcoholism, or alcohol use disorders (AUDs), represent a major public health concern both locally and globally. Critically, excessive alcohol consumption results in neurodegeneration in brain regions such as the hippocampus which is known for its role in learning and memory. Recovery of hippocampal volume loss has been observed after prolonged abstinence, but the mechanisms underlying this process are not well understood. Adult neurogenesis is thought to contribute to this recovery since after alcohol exposure a reactive increase in adult neurogenesis is observed. This reactive neurogenesis (the process by which brain insult results in a compensatory increase in neurogenesis) may represent …

Breastfeeding Practices Among Native Hawaiians And Pacific Islanders, Ingrid K. Adams, Chizimuzo T.C. Okoli, Akilah Dulin Keita, Ana Maria Linares, Keiko Tanaka, Joshua R. Polanin, Annie Koempel

Dietetics and Human Nutrition Faculty Publications

Background. Breastfeeding is associated with a decreased risk of obesity in the early and adult years. Native Hawaiians and Pacific Islanders (NHPI) experience high rates of obesity which is often obfuscated with aggregated data. Using disaggregated data, we examined breastfeeding practices among NHPI. Methods. Seven databases and reference lists were searched. Two independent researchers extracted relevant studies based on predetermined criteria. Nine studies met our inclusion criteria and a meta-analysis was conducted using random-effects, inverse-various weighted models. Results. Few studies disaggregated NHPI populations when examining breastfeeding practices. Most studies were cross-sectional and our search yielded no randomized or quasirandomized control …

Risk Factors Associated With Severe Injuries In Inland Aquaculture Farms, Amah Martin

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Objective: The main objective of this study was to analyze risk factors associated with severe occupational injuries among inland aquaculture farms.

Methods: Survey results were compiled in a data set that consisted of qualitative data from 51 farmers who were interviewed between 2008 and 2011 in 10 states and the Canadian province of British Columbia. Chi-square and Fisher’s exact test were used to assess the differences in the dichotomous level of severity among several farm and injury variables. Logistic regression was used to predict the outcome of a severe injury event.

Results: Injury observations that indicated the use of raceway …

Local Health Department Choice In The Provision Of Cancer And Cardiovascular Disease Screening, Georgianne Tiu

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Clinical preventive services, such as cancer and cardiovascular (CVD) disease screenings are critical components essential for reaching optimal population health outcomes. Although clinical preventive services are recognized to save lives, roughly three-fourths of adults between the ages of 50 and 64 and over 50% of adults aged 65 years and older forego clinical preventive services. Private medical practitioners can provide such services. However, public sector entities, such as local health departments (LHDs), can also deliver them in addition to population based activities. Because of a possible substitution effect among health systems, we hypothesized that a LHD’s choice to be involved …

Hiv Testing Health Care Related Discrimination Among Black And White Men From The 2006-2008 Sexual Acquisition And Transmission Of Hiv Cooperative Agreement Program (Sathcap), Kenisha Cantrell

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Background: The study investigated whether experiencing difficulty obtaining heath care due to different forms of discrimination impacts Black and White men being tested for HIV. It is important to discover if discrimination as a structural factor inhibits progression through the HIV Care Continuum among Black men. Structural factors may better explain the origin of HIV prevalence disparities and how the social factors affect Black men being tested for HIV.

Methods: Data utilized was collected through the 2006-2008 Sexual Acquisition and Transmission of HIV Cooperative Agreement Program implemented in 6 U.S. cities and one Russian city: Los Angeles, CA; Chicago, IL; …

Injuries Among Security And Law Enforcement Personnel In The Private Versus Public Sectors, William S. Witt

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Background and Objectives: Data collected through workers’ compensation may be useful for occupational injury surveillance. This study examined whether differences existed between the public and private sectors of the security and law enforcement industry in Kentucky.

Methods: Using a cross-­‐sectional design, workers’ compensation data from the Kentucky Department of Workers’ Claims was analyzed to evaluate differences in demographic and injury characteristics, as well as award outcomes, stratified by industry sector. The dataset included all workers’ compensation first reports of injury and claims filed by security and law enforcement personnel in Kentucky from 2005 to 2015. Statistical analyzes included chi-­‐square and …

Comparison Of The Difference In Nephrotoxicity Between Nafcillin And Piperacillin-Tazobactam, Sonali Kishor Patel

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Objective

To evaluate whether nephrotoxicity differs between nafcillin and piperacillin-tazobactam in adult hospitalized patients.

Introduction

Acute kidney injury (AKI) is a significant cause of morbidity and mortality in the inpatient setting, with antibiotics being a significant contributor. There is evidence of an increased risk of nephrotoxicity with the combination of vancomycin and piperacillin-tazobactam compared to vancomycin and cefepime or vancomycin alone. It is unknown whether this effect is exclusive for piperacillin-tazobactam. Therefore, in order to promote optimal medication therapy for inpatient bacterial infections, there is a need to assess the persistence of this difference in other beta-lactam antibiotics.

Methods

A …

Comparing The Non-Cystic Fibrosis Bronchiectasis Patients With Non-Tuberculous Mycobacteria (Ntm) And Non-Ntm Infections, Maninder Bir Singh

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Objective

The objective of the study is to compare the Non-Cystic Fibrosis Bronchiectasis patients with Non Tubercular Mycobacteria (NTM) and Non-NTM infection and determine if the NTM and Non-NTM groups are different.

Methods

Data from the COPD Foundation’s Bronchiectasis Research Registry (BRR) was used in the study (n=1660).Logistic regression, Cox proportional hazards regression, and Kaplan Meier survival analysis were used to analyze the data.

Results

The study found odds ratio for having NTM infection for age to be 1.02 and for gender to be 2.34, after adjusting for all other variables in the multivariate logistic regression, with the p-value of …

Eat Well, Keep Moving: Decreasing Childhood Obesity In Fulton County, Kentucky, Sandra Onekhena

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

With the high rates of childhood obesity in Fulton County, the Purchase District Health Department proposes the implementation of the Eat Well and Keep Moving Program in all the county’s elementary schools among fourth and fifth graders. It is an interdisciplinary, evidence-based program that will be aimed at our short-term goal of increasing knowledge about nutrition and physical activity and inspiring positive behavioral change. It works by integrating lessons and activities about proper nutrition and activity into various aspects of the children’s lives — in the classroom, cafeteria, at home and in the community. We hope to see children move …

Neurotoxic Effects Of Occupational Exposures In Agricultural Workers, Miriam Siegel

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Background: Pesticides and organic solvents are two classes of neurotoxic substances regularly used in agriculture. Pesticides have been studied in relation to a range of nervous system effects, and have been repeatedly shown to relate to depression in agricultural workers. Likewise, occupational solvent exposure is recognized as a risk factor for central nervous system effects, including mood disturbances and cognitive impairment, across various industries. Many gaps in knowledge regarding the effects of chronic exposure to these substances on mental/neurological health in agricultural workers still exist. The specific aims of the current analysis were to 1.) Estimate associations between metrics of …

Examining Associations Between Prevalence Of Chronic Obstructive Pulmonary Disease And Self-Perceived Health-Related Quality Of Life Among Adults In Kentucky, Seth Siameh

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Introduction

The objective of this study is to examine associations between Chronic Obstructive Pulmonary Disease (COPD) prevalence in Kentucky and measures of health-related quality of life (HRQOL) using a large population-based sample.

Methods

Data from the 2013 Kentucky Behavioral Risk Factor Surveillance System (BRFSS) was used to calculate age-adjusted prevalence of COPD among various population subgroups (N=10,958). Multivariable logistic regression models were used to estimate adjusted odds ratios for COPD and HRQOL measures.

Results

In 2013, the age-adjusted prevalence of self-reported COPD among Kentucky adults aged ≥18 years was 10.3% (standard error [SE], ±0.4; 95% CI, 9.5 – 11.2). Kentucky …